Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease. It is called “chest paralysis” and “heart pain” in Chinese medicine, and is one of the most common cardiovascular diseases, which develops into cardiac insufficiency and heart failure at a later stage. This is due to chronic ischemia and other factors, so that the heart’s ability to function decreases and loses its compensatory capacity, the heart output decreases, the return blood cannot be fully discharged, the venous return is blocked, so that the blood supply to the organs is insufficient to meet the metabolic needs of the body, and the stasis pressure in the venous system increases, while the neuroendocrine system activates, over-secretion of catecholamines and inflammatory mediators, which aggravates the dysfunction of the circulatory system, resulting in a series of symptoms such as hemodynamic dysfunction and neuroendocrine activation and loss of compensation. The clinical syndrome is called “palpitations”, “palpitation”, “coughing and wheezing”, “phlegm drinking”, “edema”, and “edema” in Chinese medicine. Chinese medicine is known as “palpitation”, “palpitation”, “coughing and wheezing”, “phlegm-drinking”, “edema”, “blood stasis”, “heart paralysis” and other symptoms.
Modern medicine believes that the disease is due to atherosclerosis of coronary arteries, plaque formation, endothelial cell dysfunction resulting in luminal narrowing and vascular spasm, resulting in myocardial ischemia and hypoxia. The understanding of Chinese and Western medicine is quite consistent on this point. Chinese medicine believes that the cause of heart vein blockage is certainly due to blood stasis, phlegm and qi stagnation, while phlegm and qi stagnation are the result of long-standing dysfunction of the internal organs. When qi stagnation, phlegm turbidity, blood stasis, each other as a cause and effect, blocking the heart, qi and blood can not flow normally, then there is “no pass is pain”, or its pain is not very, more insidious, and sometimes stop, more frequent, years and months, from the real to deficient, long-term disease will hurt qi and blood, and cause heart failure.
At this time, the body’s qi and blood, yin and yang, are in varying degrees of deficiency, that is, the so-called “Nei Jing” over half a hundred years old, yin and blood since half, so heart yang, heart qi deficiency, heart yin heart blood deficiency, is the pathological basis of heart failure. The deficiency of heart yin and yang qi and blood is closely related to the deficiency of qi and blood stasis and blood vessels. Qi is the handsome of the blood, qi line is blood line, yang deficiency is unable to push the blood; yin blood deficiency, the blood line is also unfavorable, so “yang deficiency blood will condense, yin deficiency blood will stagnate. The heart is closely related to other organs, such as the heart and kidney Yang deficiency, heart disease and spleen, heart and lung deficiency. The kidney is the master of yin and yang, and is the master of the water channel. A deficiency of yin affects the heart and yang; a deficiency of the lung affects the heart and yang, resulting in a deficiency of heart qi and heart qi, which cannot warm the heart veins, causing palpitations, wheezing, edema and blood stasis. This is the same understanding as in Western medicine. Cardiac insufficiency decreases circulatory function, causing hypotension, resulting in inadequate irrigation of various organ tissues and acute or chronic ischemia and hypoxia; cardiac insufficiency also activates renin-angiotensin, sympathetic nervous system, energy metabolic system, increased secretion of catecholamines, inflammatory mediators and other bioactive substances, causing other organ dysfunction or even failure. For example, it affects the lungs, brain, kidneys, gastrointestinal organs, causing cardio-cerebral, cardio-lung, cardio-renal syndrome, and gastrointestinal tract due to ischemia and hypoxia leading to gastrointestinal insufficiency.
Pathogenesis.
The root cause of heart failure in coronary heart disease lies in the original deficiency. On this basis, external evil repeatedly invades, phlegm and drinks congest the lung, the lung loses its declaration and descent, water overflows and floods, watercourses do not work, Qi-chemistry is not normal, too much stagnant fluid cannot flow back and overflows outside the pulse and develops into water, causing edema. Blood stasis blocks the veins and collaterals, resulting in obstruction of water and fluid flow, which in turn can block the flow of Wei Qi and Ying Blood, causing Qi deficiency and weakness of the veins, resulting in weakness of blood flow and stasis of the veins and collaterals, resulting in weakness of heart Qi, heart Yin and heart Yang over time, and developing into heart failure.
In Chinese medicine, “heart accumulation” and “heart water” are comparable to chronic heart failure, and the so-called “qi division” is actually a malfunction in the movement of the qi and qi-transformation of the ying qi, covering neurohormonal activation, ventricular reconstruction, heart enlargement, and heart function. It covers the pathological process of neurohormonal activation, ventricular remodeling, heart enlargement, and gradual decompensation of cardiac function; the so-called “blood component” covers the pathological changes of hemodynamics, and the abnormal vasodilation and contraction functions that increase the load on the heart. The understanding of heart failure in TCM is consistent with the pathophysiological changes of heart failure revealed by modern medicine.
1, deficiency of qi and blood: chest tightness, palpitations, aggravated by exertion is a common symptom, stagnation of the heart veins, repeated sensation of external evil, thought, labor and fatigue, the six external evil and other triggers, so that the movement of blood and Ying is not smooth, blood stagnation aggravated; can also be due to Yang deficiency, can not warm the heart veins, heart Yang is not revitalized and palpitations; can also be due to Yang deficiency can not control water, drinking evil on the offense, so that palpitations; long-standing weakness, heart blood deficiency, heart loss of nourishment, God can not be hidden can also occur when palpitations; loss of kidney yang, yin deficiency fire, heart fire delusion, will also palpitations.
2, blood stasis and water stoppage: insufficient heart qi, blood movement is weak, qi is the handsome of blood, blood is the mother of qi, qi movement is blood movement, qi deficiency is blood stasis; blood stagnation, fluid can not flow back, blood overflow pulse outside the water, causing edema, swelling from the bottom up, sunken and difficult to rise, called Yin Shui, and heart, lung, spleen, kidney organs deficiency are related. Due to deficiency of Yang in the heart and spleen, Qi does not transform water, resulting in flooding of water-dampness in the lower jiao, resulting in swelling of the lower extremities, poor appetite and loose stools, distention and fullness of the abdomen, and weakness of kidney Yang, resulting in internal flourishing of water qi, resulting in edema below the waist.
3. Heart disease and lung, spleen, kidney and liver, resulting in dysfunction: Heart failure first involves the lung, then the liver, spleen and kidney can be involved, so heart, lung, spleen, liver and kidney functions are closely related. Cough is not only limited to the heart and lungs, but can also cause asthma in all the five viscera and six internal organs. In the late stage of heart failure, all internal organs can become dysfunctional and even fail.
Dialectical treatment.
Activating blood circulation and resolving blood stasis is the main treatment for coronary heart disease, and is also one of the pathogenic mechanisms of chest paralysis and heart failure, and is used throughout the treatment process. In the acute phase of heart failure, the main treatment is to treat the symptoms, while in the chronic phase, both the symptoms and the root cause are treated, and the main symptoms are described as follows.
1. Heart Yang deficiency
[Symptoms]: Heart panic, chest tightness, palpitations, aggravated by exertion, cold, or feeling external evil. Thin white tongue coating, thin pulse or knotted generation.
[Treatment]: Benefiting Qi, warming Yang, activating Blood circulation and resolving blood stasis.
[Formula]: Radix et Rhizoma prunus 15g, Radix et Rhizoma Polygoni 10g, Radix et Rhizoma Gui 10g, Rhizoma Atractylodes Macrocephala 15g, Radix Salviae Miltiorrhizae 15g, Rhizoma Ligustici Chuanxiong 8g, Radix Safflower 10g.
2. Heart and Spleen Yang Deficiency
[Symptoms]: Palpitations, shortness of breath, shortness of breath with daily activities, aggravated by movement, abdominal distension, nausea and vomiting, swelling of lower limbs. The coating is white and greasy, and the pulse is thin and knotted.
[Treatment]: Strengthening the spleen, warming Yang, benefiting Qi and invigorating Blood.
[Formula]: Radix et Rhizoma Polygoni 15g, Radix Codonopsis 25g, Poria 15g, Rhizoma Atractylodes 15g, Radix Glycyrrhiza Glabra 6g, Rhizoma Miltiorrhizae 30g, Radix Gui Zhi 10g, Plantago Major 20g, Radix Salviae Miltiorrhizae 20g, Peach kernel 6g, Safflower 10g, Rhizoma Ligustici Chuanxiong 8g, Melon Peel 15g.
3.Yang deficiency of the heart and kidney
[Symptoms]: Palpitations and shortness of breath, cold in the extremities, puffiness and swelling, weakness and dullness, purple face and lips, purple lips and tongue, white fur, sunken and weak pulse.
[Treatment]: Warming Yang and promoting diuresis, benefiting Qi, activating blood circulation and resolving blood stasis
[Formula]: Radix et Rhizoma Polygonati 15g, Radix et Rhizoma Polygonati 10g, Poria 15g, Atractylodes Macrocephala 15g, Ginger 6g, Gui Zhi 10g, Ze Xie 12g, Plantain 20g, Radix Astragali 20g, Salvia 15g, Rhizoma Chuanxiong 8g.
4. Qi and Yin deficiency
[Symptoms]: Palpitations and palpitations, dizziness, shortness of breath, dry mouth, insomnia and night sweating, red tongue with little coating, thin pulse, and knotted generation.
[Treatment]: Benefiting Qi and nourishing Yin, promoting Qi and activating Blood circulation.
[Formula]: Ginseng 12g, Mai Dong 12g, Wu Wei Zi 10g, Roasted Licorice 6g, Ginger 6g, Radix et Rhizoma 10g, Colla Corii Asini 10g, Salviae Miltiorrhiza 15g, Radix Astragali 20g.
5.Qi deficiency and blood stasis
[Symptoms]: Palpitations and palpitations, pain in the chest and hypochondrium, fullness in the abdomen, coughing and shortness of breath, dark red cheekbones, blue lips, swelling and urination, chest tightness and shortness of breath even at rest, purple and dark tongue, astringent or string pulse, and knotted generation.
[Treatment]: Benefiting Qi, activating Blood circulation and resolving blood stasis.
[Formula]: Radix Codonopsis pilosulae 15g, Salviae Miltiorrhiza 30g, Rhizoma Ligustici Chuanxiong 8g, Radix Paeoniae 10g, Safflower 10g, Radix et Rhizoma Yanhuosuo 10g, Radix Astragali 25g, Radix Aromaticus 10g, Peach kernel 9g, Bupleurum 10g, Citrus Aurantium 9g.
6.Phlegm Drinking Blocking Lung
[Symptoms]: Panic and shortness of breath, coughing and stagnation of breath, coughing white phlegm or foamy liquid phlegm, abdominal distension and dullness, mental inactivity, puffiness and swelling with little urination. Diarrhea of the lung and diuresis of the tongue, moving Qi and resolving stasis, relieving cough and asthma.
[Formula]: Dracaena scabra 15g, jujube 10, roasted licorice 6g, ginger and semen 10g, wu wei zi 9g, roasted ephedra 6g, almond 9g, sage 10g, codonopsis 15g, raw astragalus 20g, salvia 15g, cinnamon 10g, zelen 12g
7.Yang Qi deficiency, Yin and Yang both decline
[Symptoms]: Palpitations and shortness of breath are extremely severe, shortness of breath, nasal agitation, opening the mouth and lifting the shoulders, restlessness, blue and gray face, or indifference, profuse sweating, cold extremities, edema of the limbs, pale white tongue, sunken and thin pulse.
[Treatment]: Returning Yang to save rebellion, benefiting Qi and fixing detachment.
[Radix et Rhizoma Ginseng 10g, Radix Aconiti 10g, Radix Gui Zhi 12g, Radix Maldonae 15g, Fructus Schisandrae 15g, Radix keel 30g, Radix oyster 30g, Radix et Rhizoma Glycyrrhiza 9g, Cornu Cervi Pantotrichum 30g, Radix Salviae Miltiorrhizae 15g, Radix Scrophulariae 15g, Radix Zeligae 12g.